Résultats après allongement des triceps par bottes successives et rééducation spécifique chez les enfants IMC

We evaluated the efficacy of combined progressive casts and intensive functional rehabilitation and braces for lengthening the triceps and improve gait cerebral palsy children. Seventeen children with cerebral palsy (ten diparetic and seven hemiparetic) aged 3 - 9 years were included in this study. All could walk alone, except one who required a walker. Boot casts were fashioned for periods of one to three weeks. A total of 22 lengthenings were performed: two cases for one week each (n=9) three casts for one week each (n=1), one cast for one week (n=12). After removing the casts, braces were used to maintain extension and facilitate gait. The same intensive physiotherapy protocol was used for all patients with for to five sessions per week for one month. Tibiotarsal angle, gait analysis and overall functional motor analysis were used for assessment of outcome. Mean passive dorsal tibiotarsal flexion before treatment was +6.7° with knee flexed (soleus) and -2.2° with knee extended (gastrocnemius). Mean angle after removal of the casts was 16.2° (soleus) and 15.4° (gastrocnemius). After five months, a third assessment of triceps length demonstrated a mean lengthening of 76% for the soleus and 72% for the gastrocnemius. The man loss of extension was 4.2° for the soleus and 4.3° for the gastrocnemius Mean functional benefice was 6.4%. In these cerebral palsy children who had been walking for a long time using a well-structured gait, the greatest functional modification was obtained in the biparetic children, mean improvement 7.8%, compared with the hemiparetic children, mean improvement 4%.